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Schimmer, R., Orre, C., Öberg, U., Danielsson, K. & Hörnsten, Å. (2019). Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges. JMIR Diabetes, 4(3), 1-10, Article ID 10702.
Open this publication in new window or tab >>Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges
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2019 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 4, no 3, p. 1-10, article id 10702Article in journal (Refereed) Published
Abstract [en]

Background: Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce.

Objective: The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D.

Methods: A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data.

Results: Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service.

Conclusions: A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.

Keywords
eHealth, diabetes mellitus, type 2, informatics, nursing, patient-centered care, self-management
National Category
Information Systems, Social aspects
Research subject
människa-dator interaktion; caring sciences in social sciences
Identifiers
urn:nbn:se:umu:diva-163461 (URN)10.2196/10702 (DOI)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-20Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2019). Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation. European Journal of Cardiovascular Nursing, 18(7), 593-600
Open this publication in new window or tab >>Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 593-600Article in journal (Refereed) Published
Abstract [en]

Background: Transcatheter aortic valve implantation may be indicated for patients with aortic stenosis and high risk of postoperative mortality. The assessment of suitability for transcatheter aortic valve implantation requires consensus agreement of a team of cardiologists and cardiac surgeons. The burden of comorbidities, frailty and cognitive impairment are factors included when risks for transcatheter aortic valve implantation are balanced against the expected benefits. Although transcatheter aortic valve implantation is a possibility for many, there are still ineligible patients. Knowledge of their experiences of being deemed ineligible are lacking. Aim: The aim of this study was to explore patients' experiences of being considered for transcatheter aortic valve implantation but judged ineligible. Methods: Individual in-depth interviews were performed with eight persons, and qualitative content analysis was used for the analysis. Results: Being ineligible for transcatheter aortic valve implantation may induce both hope and despair. Hope was linked to experiences of acceptance, relief of symptoms, support and control; despair was associated with feelings of being missed and abandoned, and of grief and insecurity. Some expressed great anxiety, since their incurable heart disease meant an imminent death. Others were more concerned over practical problems that affected everyday life. Conclusion: Being ineligible for transcatheter aortic valve implantation does not necessarily lead to despair. Hope is built through relationships, continuity and support. A combination of person-centred care and palliative care during the end-of-life phase should be offered to patients in order to help clients re-conceptualise hope during this stage of their illness. Cardiovascular nurses in the transcatheter aortic valve implantation team are suitable to facilitate continued care based on the patient's needs, desires and local conditions.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Aortic stenosis, transcatheter aortic valve implantation, incurable, hope, person-centred care
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-164036 (URN)10.1177/1474515119852209 (DOI)000487801400010 ()31113221 (PubMedID)
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Nordlander, M., Isaksson, U. & Hörnsten, Å. (2019). Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution. Sage Open Nursing, 5
Open this publication in new window or tab >>Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution
2019 (English)In: Sage Open Nursing, ISSN 2377-9608, Vol. 5Article in journal (Refereed) Published
Abstract [en]

The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
appetite, home-living elderly people, perceptions, food distribution, interviews, nursing
National Category
Nursing Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-156877 (URN)10.1177/2377960818817126 (DOI)000458647600001 ()
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-03-11Bibliographically approved
Öberg, U., Isaksson, U., Jutterström, L., Orre, C. & Hörnsten, Å. (2019). Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 8(4), Article ID e10250.
Open this publication in new window or tab >>Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 4, article id e10250Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs.

OBJECTIVE: To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care.

METHODS: This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA1c) will be the primary outcome measure.

RESULTS: This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019.

CONCLUSIONS: This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10250.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
eHealth, internet, mobile apps, nurse specialists, primary health care, randomized controlled trial, self-management, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158655 (URN)10.2196/10250 (DOI)000466496800003 ()30958279 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-06-10Bibliographically approved
Sjöström, A. E., Hörnsten, Å., Hajdarevic, S., Emmoth, A. & Isaksson, U. (2019). Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study. JMIR Nursing, 2(1), Article ID e14194.
Open this publication in new window or tab >>Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study
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2019 (English)In: JMIR Nursing, ISSN 2562-7600, Vol. 2, no 1, article id e14194Article in journal (Refereed) Published
Abstract [en]

Background: Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

Objective: The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

Methods: This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

Results: The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

Conclusions: Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
eHealth, Internet, consumer health information, health literacy, patient-centered care, qualitative research, primary health care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162733 (URN)10.2196/14194 (DOI)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30Bibliographically approved
Öberg, U., Hörnsten, Å. & Isaksson, U. (2019). The Self‐Management Assessment Scale: development and psychometric testing of a screening instrument for person‐centred guidance and self‐management support. Nursing Open, 6, 504-513
Open this publication in new window or tab >>The Self‐Management Assessment Scale: development and psychometric testing of a screening instrument for person‐centred guidance and self‐management support
2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, p. 504-513Article in journal (Refereed) Published
Abstract [en]

Aim: To develop and psychometrically test the Self‐Management Assessment Scale (SMASc), a screening instrument for person‐centred guidance and self‐management support of persons with type 2 diabetes (T2D).

Background: T2D is a common and globally increasing chronic condition. Improved self‐management is a vital and integral component of diabetes care to prevent complications from poorly managed diabetes. For diabetes nurses to better understand persons with diabetes experienced challenges and needs regarding self‐management and further for persons with T2D to take an active role in managing their condition, an instrument measuring this is needed.

Design: Instrument development and psychometric testing of the content and construct validity, factor structure and reliability.

Method: The SMASc was psychometric tested on a sample of participants (September 2017–November 2017) with a confirmed diagnosis of T2D (N = 104).

Results: Psychometric findings were satisfactory and supported the scale´s reliability. Cronbach's alpha, CVI and goodness‐of‐fit were acceptable.

Conclusion: Self‐Management Assessment Scale is a short validated screening instrument, which can indicate possible barriers for self‐management that ought to be approached during the conversation between the person with T2D and the primary healthcare nurses. Therefore, it is a promising instrument to be used to facilitate person‐centred guidance and to improve self‐management of people living with T2D.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
instrument development, nursing, person‐centred care, psychometric properties, self‐management support, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155317 (URN)10.1002/nop2.233 (DOI)000461835600030 ()30918701 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-05-16Bibliographically approved
Hultstrand Ahlin, C., Hörnsten, Å., Coe, A.-B., Lilja, M. & Hajdarevic, S. (2019). Wishing to be perceived as a capable and resourceful person: A qualitative study of melanoma patients’ experiences of the contact and interaction with healthcare professionals. Journal of Clinical Nursing, 28(7–8), 1223-1232
Open this publication in new window or tab >>Wishing to be perceived as a capable and resourceful person: A qualitative study of melanoma patients’ experiences of the contact and interaction with healthcare professionals
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2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1223-1232Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To explore patients' experiences of contact and interaction with healthcare professionals (HCPs) during the diagnostic process of melanoma.

BACKGROUND: In Sweden, most patients with suspected skin lesions seek care at the primary level of services in the first instance. Previous research describes the diagnostic process as a complex journey with uncertainty. Nonetheless, the importance of contact and interaction between patient and HCPs during the diagnostic process is rarely explored.

DESIGN: This study adopted a qualitative design in which semi-structured interviews were conducted and the COREQ-checklist for qualitative studies employed (EQUATOR guidelines).

METHODS: A sample of 30 patients (15 women, 15 men) diagnosed with melanoma was included. Secondary analysis of interviews was carried out using qualitative content analysis.

RESULTS: One theme emerged: Wishing to be perceived as a capable and resourceful person that consisted of three categories: (a) The need of being valued, (b) The need of being informed and (c) The need of taking actions.

CONCLUSIONS: Our results suggest that patients wish to be valued as capable and resourceful persons as well as to be provided with honest and sufficient information about the diagnosis and subsequent procedures. By fulfilling these wishes, HCPs can involve patients in the diagnostic process and reduce patients' uncertainty. A need of supportive and accessible health care to manage the diagnostic process and to reduce patients' struggle for care was also identified.

RELEVANCE TO THE CLINICAL PRACTICE: Patients are satisfied when health care is organised in a patient-/person-centred manner, that is, in accordance with patients' needs, avoiding gatekeeping, and when HCPs interact respectfully in encounters. Accessible HCPs during the diagnostic process of melanoma are required to inform, support and navigate patients within the healthcare system and through their diagnostic journey.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
cancer, care needs, healthcare professional-patient relationship, patient-centred care, patients’ experience, qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155315 (URN)10.1111/jocn.14730 (DOI)000460767400018 ()30549354 (PubMedID)2-s2.0-85059608526 (Scopus ID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-10-16Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2018). Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study. Nursing Open, 5(2), 149-157
Open this publication in new window or tab >>Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 149-157Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design: A qualitative approach where in-depth interviews were used. Method: Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results: The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
aortic stenosis, coping, hope, qualitative study, recovery, supportive nursing, transcatheter aortic valve implantation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-148639 (URN)10.1002/nop2.124 (DOI)000428455600006 ()29599990 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2018-06-25Bibliographically approved
Öberg, U., Isaksson, U., Jutterström, L., Orre, C.-J. & Hörnsten, Å. (2018). Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support. JMIR Diabetes, 3(1), Article ID e7.
Open this publication in new window or tab >>Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support
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2018 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 3, no 1, article id e7Article in journal (Refereed) Published
Abstract [en]

Background: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.

Objective: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.

Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.

Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

Place, publisher, year, edition, pages
JMIR Publications, 2018
Keywords
eHealth, internet, type 2 diabetes, self-management, primary health care, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145997 (URN)10.2196/diabetes.9059 (DOI)30291075 (PubMedID)2-s2.0-85047781902 (Scopus ID)
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2019-05-16Bibliographically approved
Öberg, U., Orre, C.-J., Isaksson, U., Schimmer, R., Larsson, H. & Hörnsten, Å. (2018). Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scandinavian Journal of Caring Sciences, 32(2), 961-970
Open this publication in new window or tab >>Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management
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2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 961-970Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care.

AIM: The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management.

METHODS: Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis.

RESULTS: Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.

Keywords
chronic conditions, eHealth, nurses, primary health care, self-management, technology, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145996 (URN)10.1111/scs.12534 (DOI)000436254800053 ()28960451 (PubMedID)
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2019-05-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1543-6512

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